summary Upper Extremity Disorders in Cerebral Palsy are caused by spasticity and can take the form of shoulder, elbow, wrist, or hand contractures. Diagnosis is made clinically with restriction or limitations in motion of the shoulder, elbow, wrist, hand or fingers, secondary to spasticity. Treatment can range from bracing to surgical soft tissue release or osteotomy depending on severity of deformity, limitations in ability to maintain hygiene, and functional deficits. Epidemiology Demographics typically seen in in patients with hemiplegia and quadriplegia Etiology See Cerebral Palsy General Characteristic deformities include shoulder internal rotation contracture forearm-pronation / elbow flexion deformity wrist-flexion deformity thumb-in-palm deformity finger-flexion deformity Treatment of upper extremity conditions can be divided into hygienic procedures indicated to maintain hygiene in patients with decreased mental and physical function functional procedures indicated in patients with voluntary control, IQ of 50-70 or higher, and better sensibility Shoulder IR Contracture Overview characterized by glenohumeral internal rotation contracture Treatment shoulder derotational osteotomy and/or subscapularis and pectoralis lengthening with biceps/brachialis lengthening capsulotomy indications login to view 1 more bullet Forearm-Pronation / Elbow-Flexion Deformity Overview usually consists of a combination of a forearm pronation deformity and elbow flexion contracture Treatment lacertus fibrosis release, biceps and brachialis lengthening, brachioradialis origin release indications login to view 1 more bullet pronator teres release indications login to view 1 more bullet technique login to view 1 more bullet complication login to view 2 more bullets FCU transfer transfer of the FCU to the ECRB login to view 2 more bullets Wrist-Flexion Deformity Overview wrist is typically flexed and in ulnar deviation associated with weak wrist extension and pronation of the forearm Phyiscal exam Assessing a wrist flexion contracture is done by extending all the fingers with the wrist in maximal flexion, then extending the wrist. The degree to which the wrist cannot fully extend is the Volkmann angle. Treatment FCU or FCR lengthening indications login to view 1 more bullet Tendon Transfers (FCU to ECRB or FCU to EDC transfer) indications login to view 8 more bullets flexor release indications login to view 1 more bullet technique login to view 1 more bullet wrist arthrodesis indications login to view 1 more bullet Thumb-in-Palm Deformity Introduction flexed thumb into palm prevents grasping and pinching activities can preclude appropriate hygiene Classification (House) House Classification Type Characteristics Treatment Type I 1st metacarpal adduction contracture Adductor release, possible 1st dorsal interosseous release Z-plasty of the skin contracture in the 1st web Type II 1st metacarpal adduction contracture + contracture of the MP joint Adductor release Release of FPB Type III 1st metacarpal adduction contracture +unstable or hyperextendable MPJ Adductor release Fusion or capsulodesis of the MP joint Type IV 1st metacarpal adduction contracture + MPJ and IPJ flexion contractures Adductor release FPB and FPL release or lengthening Treatment release of the adductor pollicis, transfer of tendons, and stabilization of the MCP joint indications login to view 1 more bullet Finger-Flexion Deformity Introduction a result of intrinsic muscle tightness along with extrinsic overpull of the finger extensors Treatment swan-neck deformities can often be helped with correction of the wrist flexion deformity